Any unemployed physicians out there? # of MD graduates =/= residency spots

[PharmaTope]

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just curious. Considering the number of graduates is more than the number of residencies out there.

Coming out 200k in debt with no residency, what are you doing about this?

 

[themule]

just curious. Considering the number of graduates is more than the number of residencies out there.

Coming out 200k in debt with no residency, what are you doing about this?

The last that I had read there were more US residencies then there are US allo/osteo grads and the remainder are filled with FMGs and IMGs.

 

[peppy]

Check out the Pathology forum. There is a lot of talk there about the problems in that specialty with finding jobs.
There is also a guy who likes to post on the general residency forum (turquioseblue) who has had a lot of trouble with getting a stable residency spot.
There really aren't that many physicians right now who have trouble finding work, but I do think it's something that could potentially be a problem in the near future.

 

[PharmaTope]

Check out the Pathology forum. There is a lot of talk there about the problems in that specialty with finding jobs.
There is also a guy who likes to post on the general residency forum (turquioseblue) who has had a lot of trouble with getting a stable residency spot.
There really aren't that many physicians right now who have trouble finding work, but I do think it's something that could potentially be a problem in the near future.

thanks for the info peppy. i see some more schools opening and i was under the impression that the number of residencies available in the US were not adequate for the number of graduating MDs

 

[Gabby]

The last that I had read there were more US residencies then there are US allo/osteo grads and the remainder are filled with FMGs and IMGs.

For the first time this year, there were less scramble spots than there were U.S. MD students who needed to scramble.

 

[themule]

For the first time this year, there were less scramble spots than there were U.S. MD students who needed to scramble.

Right, but only 45% of FM spots and 55% of IM spots went to US grads. The rest were made up of IMGs and FMGs. So there were plenty of spots but they were taken by FMGs and IMGs. The amount of residency spots available today does little or nothing to help correct our projected physician shortage and they should be raised for this very reason. But there are more residency positions then there are US grads currently.

 

[Mr hawkings]

Right, but only 45% of FM spots and 55% of IM spots went to US grads. The rest were made up of IMGs and FMGs. So there were plenty of spots but they were taken by FMGs and IMGs. The amount of residency spots available today does little or nothing to help correct our projected physician shortage and they should be raised for this very reason. But there are more residency positions then there are US grads currently.

Yeah but they were in places that the US grad did not want to go to. I had a friend who opted to sit out a year to do research instead of scrambling into a spot in Alabama. He was married with a kid and his wife owned a business in california that she couldn't relocate.
He had a good reason, but i've heard stories of people not matching cos they have a very short list of places they would go and then refuse to scambling into spots in places that they deem unnatractive.

 

[Raryn]

There are currently >1.5x as many Residency spots as there are Allopathic US graduates.

The 1/3 extra spots are taken up by DOs, IMG/FMGs, and the (very few) folks going back for a second residency. Basically they could increase the # of US allopathic med students by 50% and we would still all find *a* residency, but maybe not the one we want. (Do you want to do family med in rural Montana or something? I don't.)

DOs would end up suffering quite a bit though, because even though the majority of their designated residency spots currently go empty, there are more DO graduates than there are DO residencies. They just assume (correctly) that a good portion of them chose to go to ACGME recognized programs. (Its rather unfair that they have exclusive residencies but ours are open to anyone that can take the USMLE. But thats an argument for another day).

 

[lowbudget]

Check out the Pathology forum. There is a lot of talk there about the problems in that specialty with finding jobs.

Has the CSI bubble finally burst? Hmmm... interesting.

 

[bronx43]

New medical schools are popping up like crazy around the US. In theory, that really only hurts the FMG's and the IMG's.

The real issue is what happens after residency. As someone mentioned, pathology residents are probably shaking in their boots, because there are more graduating pathologists than there are full-time positions.

Markets are just getting more and more saturated as time goes by. For any field, if you want to live in a major metropolitan area, be prepared to take a pretty hefty pay cut... that is if you can even find a position at all.

 

[themule]

New medical schools are popping up like crazy around the US. In theory, that really only hurts the FMG's and the IMG's.

The real issue is what happens after residency. As someone mentioned, pathology residents are probably shaking in their boots, because there are more graduating pathologists than there are full-time positions.

Markets are just getting more and more saturated as time goes by. For any field, if you want to live in a major metropolitan area, be prepared to take a pretty hefty pay cut... that is if you can even find a position at all.

Do you have any data that supports this assertion or is this anecdotal? I've not heard of anyone having a problem finding jobs. Personally I was told that in medicine you can: 1) live where you want, 2) make what you want, 3) do what you want (job wise). But you can only choose 2 of the 3.

 

[FutureDoc4]

Do you have any data that supports this assertion or is this anecdotal? I've not heard of anyone having a problem finding jobs. Personally I was told that in medicine you can: 1) live where you want, 2) make what you want, 3) do what you want (job wise). But you can only choose 2 of the 3.

This is becoming outdated VERY very fast. A quick jump over to the pathology forum should give you some up to date info.

 

[Doctor D]

Do you have any data that supports this assertion or is this anecdotal? I've not heard of anyone having a problem finding jobs. Personally I was told that in medicine you can: 1) live where you want, 2) make what you want, 3) do what you want (job wise). But you can only choose 2 of the 3.

This may have been true in the past and may be true for some specialties in shortage but physician reimbursement has been declining for a decade and may continue to decline. If you want to be a family doc in a rural town you will have more patients than you can see so time will become your limiting factor. There are many ways to practice medicine within each specialty however. For example if your an IM doc you can work outpatient or inpatient. 9-5 or shift work.

 

[Law2Doc]

Yeah but they were in places that the US grad did not want to go to. I had a friend who opted to sit out a year to do research instead of scrambling into a spot in Alabama. He was married with a kid and his wife owned a business in california that she couldn't relocate.
He had a good reason, but i've heard stories of people not matching cos they have a very short list of places they would go and then refuse to scambling into spots in places that they deem unnatractive.

I think that's going to be the new reality going forward -- that if you graduate from a US allo school, you can get a residency slot, but if you don't have the best of credentials, you may not have as much control over the specialty or geography as you have in years past. I think the primary care surge of US allo folks this year reflected some of that, and you can expect more and more people to go after those spots that had traditionally gone to IMGs (due to geographic and specialty undesirability) in the ensuing years. Probably means med school life is about to get a lot more competitive, because how you do will start to impact your residency choices a lot more drastically.

 

[Obnoxious Dad]

I have calculated that in the year 2017 there will not be any residency spots for FMGs even with a 75% reduction in Americans coming back from the Caribbean. Please see the attached spread sheet. This includes the DO, NRMP and San Francisco matches.

This also portends that every field from FM to integrated plastics is going to get more competitive for AMGs. AMGs will have to settle rather than choose.

 

[bronx43]

Do you have any data that supports this assertion or is this anecdotal? I've not heard of anyone having a problem finding jobs. Personally I was told that in medicine you can: 1) live where you want, 2) make what you want, 3) do what you want (job wise). But you can only choose 2 of the 3.

Which part? The pathologists not being able to find a gig part? Not sure I can find the numbers off the bat, but ask any pathology resident about the job market.

 

[turquoiseblue]

this is how i see it: there is supposedly a doctor shortage, so yes there are jobs waiting to be filled all over the place. the number of graduates i doubt exceeds the vacant physician positions out there. not to mention that in primary care specialties you often set up your own private practice among some other specialties, so there can be no limit of spots in that respect. as for hospitalist jobs im not sure, but im sure in primary care there is a void that would need to be filled (before the DNPs take over!) but im not sure about pathologists or nuclear med physicians whether they can find things easily.

 

[Law2Doc]

... not to mention that in primary care specialties you often set up your own private practice among some other specialties, so there can be no limit of spots in that respect. ....

There is absolutely a limit. The market only can bear so many people setting up shop in each community. If there are already a dozen pediatricians in your community and the business is competitive as is, having another pediatrician or two set up shop could result in bankruptcy for several. So it's a fallacy to think that you could always set up a private practice and "have a spot". Most businesses fail, and physicians are really not exceptions to this. Which is why far more people try to gain employment from existing partnerships rather than set up their own shingle right out of residency.

 

[docdaname]

This is becoming outdated VERY very fast. A quick jump over to the pathology forum should give you some up to date info.

This came up before...and I did jump over to the path forum. A recurring theme there, as well as in this forum, is that the majority of people talking about the tight job market and people not being able to get jobs (among a variety of other subjects) tend to be promoted by med students. This is sometimes followed up by a senior resident stating how everyone in their program got a job, or an attending also stating that there are still jobs. Dont be so insecure. You might not be able to get the EXACT job you want, but if you complete a residency and dont have any red flags on your record, you will be able to land a job with 2 of those 3 criteria fulfulled.

 

[DrJosephKim]

If you have geographic flexibility and you're willing to live in the south, the mid-west, etc., then you won't have problems finding jobs. The jobs are out there. The problem is that so many physicians are very selective in terms of where they wish to live.

 

[Parts Unknown]

Which part? The pathologists not being able to find a gig part? Not sure I can find the numbers off the bat, but ask any pathology resident about the job market.

The pathology job market seems to be roughly at parity, meaning there are some unemployed fellows and some unfilled jobs, and never the twain shall meet.

While I would never describe the pathology job market as "good," myself and every one of my contemporaries from residency has a position lined up. Every resident and fellow who went before me is currently employed, with the possible exception of one guy from Pakistan who had visa issues. Some live in highly popular cities, others are knee-deep in cash. I myself had multiple job offers this season, which was flattering.

I know this is anecdotal, but the pathology job market is a fairly murky and complex beast, the nature of which we have been fighting over for years. If you go to a national meeting and talk to graduating fellows, most of them will tell you the job market wasn't as bad as they expected. Some will tell you (loudly) that it's terrible. Individual results will vary, but it's not so simple as "just ask any resident."

 

[lipomas]

Man, if you pay too much attention to these forums you would think there are hundreds of thousands of unemployed physicians out there begging for jobs, board certified but yet (through no fault of their own, of course) no one can hire them. Unfortunately if you talk to REAL people this just isn't true. I know of a handful of unemployed physicians. A couple of them had their license yanked for drug problems or other legal issues. A couple quit medicine to stay home with their kids. A couple hate medicine and keep looking for the "perfect job." I also know of one who is restricting her search to a 50 mile radius. I know of one who is unemployed because he just got canned from his third failed attempt at a job in 4 years (yet, note that that did not stop jobs 2 and 3 from hiring him). I do not know of anyone who is qualified, certified or pending certification, who truly can't find a job. I am sure they are out there.

I know it really would fit everyone's little theory of chaos and the collapse of medicine to find all these unemployed physicians. A lot of people have the Ferris Bueller syndrome - I heard from this guy who is going with this girl who's friends with a guy who is getting screwed in the job market. But unfortunately for this forum all unemployed physicians don't seem to post here. I was told in the path forum that was because they are embarrassed, which is perhaps the most ludicrous argument I have ever heard in my life given that this is an anonymous forum.

Now - there are quite a few physicians who are in jobs they hate. Sometimes these are people who picked the wrong career. Sometimes its coming to terms with the fact that medicine is not the glamorous career it used to be.

That all being said, I will agree that the exploding number of med school spots, particularly in schools that charge about $50,000 a year for the privlilege of going there, is ominous. This is a disaster waiting to happen because these spots are going to be filled by increasingly marginal candidates, many of whom will want to be specialists or think they will have to be specialists because of the huge amount of loans they have. This is going to lead to some sort of trauma in the future unless real reform happens.

 

[FDoRoML]

When you look at the positions after the general match, what was open for the scramble this past March, it was not pretty. Granted, there were many open positions in the usual FM, but waaaay less than in years past (~400 vs >1000). And only 2 gen surg spots open in the whole country. And only 60-ish internal medicine spots. I'm talking categorical positions, BTW, there are plenty of prelims in medicine and surgery to scramble into. I guess the scariest issue is that it will only keep getting worse as we increase class sizes and number of med schools in the nation, per the AAMC recommendations, and the number of residency positions remains somewhat stagnant in comparison. We need the Feds to work on increasing residency positions in more than just primary care. Who is going to take care of the huge elderly population surge?

So, point is, next March there will be new grads (MD/DO/IMG/FMG) applying for categorical spots, and there will be some career-changers, AND there will be an unprecedented number of people applying from a non-designated prelim position in medicine or surgery for the same spots. Even the PDs who advise medical students were taken by complete surprise this year (not sure why, after all, all of us OCD med students had run the numbers and realized the situation). I know of four different med schools (forgive the pun) scrambling to change advising policies and catch up with the grim reality that more of their students may not match. In my school alone we had over 10 of ~150 not match... and several of these were AOA with great CVs and personalities (no logical reason why they couldn't match into even a competitive field).

Not to panic any rising MS4s out there, but I wish more of the reality dose had been offered to last year's class. You still have great odds, but have a back-up plan. And a back-up to your back-up.

 

[lipomas]

If you're an AOA with a great CV and personality who is not matching, I would bet a year's salary that it is not because there are more people in the match making it more difficult to match a spot. It would be because the individual in question had a poorly-designed strategy. Namely, they only applied to a small number of programs, only ranked a small number of competitive programs, or tried to match something that they weren't really qualified for. They may also have received poor advice from an advisor, from friends or family, or even from SDN.

You say that there were people at your school who were AOA with great CVs and personalities and there was no logical reason why they couldn't match into a competitive field. That is almost certainly false. I suspect there is a very logical reason for every such competitive candidate to fail to match. Let us not take this unfortunate development and try to incite the future panic of all med students. You mention the need for a "backup plan" but every graduating physician should think about this. This is nothing new. Since the match has been conducted there have been "top students" who have ranked 3 programs, all highly competitive, in a tough specialty, and assumed they would be alright and then fail to match. No one should be leaving the question of "will I match or not" to chance. If you are at all worried, you should be interviewing at programs that are as close to cinches as possible, and putting them last on your list.

 

[Law2Doc]

...I guess the scariest issue is that it will only keep getting worse as we increase class sizes and number of med schools in the nation, per the AAMC recommendations, and the number of residency positions remains somewhat stagnant in comparison. We need the Feds to work on increasing residency positions in more than just primary care. ...

Actually, if you read the 2005 press releases of the AAMC, this crunch is by design -- to push the offshore grads out of the equation. There has long been the sentiment that US schools should fill all US residency slots and the AAMC has been uncomfortable with the notion that there are physicians who get educated (esp) in the caribbean at programs not under the control of the LCME, and not subject to the same standards, and then come here to practice simply because we have more slots than we have grads. So having grads equal slots fixes this problem, and has the added bonus of forcing US grads into some of the primary care slots that were previously grabbed up by FMG due to being less desirable to the US crowd. This makes everyone happy other than the folks vying for a slot because the less desirable residency slots now get to choose US trained US grads, more US grads end up in primary care and FM (if only by default), and the LCME has the ability to oversee the training of everyone who becomes a US doctor. So that is the goal. And so no, there will be no pressure for the feds to increase slots because the AAMC doesn't want more slots until all the current ones are being filled by US grads.

 

[FDoRoML]

If you're an AOA with a great CV and personality who is not matching, I would bet a year's salary that it is not because there are more people in the match making it more difficult to match a spot. It would be because the individual in question had a poorly-designed strategy. Namely, they only applied to a small number of programs, only ranked a small number of competitive programs, or tried to match something that they weren't really qualified for. They may also have received poor advice from an advisor, from friends or family, or even from SDN.

I completely agree. By "no logical reason" I was not really including idiot moves and/or bad advice. I mean, in an ideal world, where med students apply to the appropriate specialty, rank the appropriate number of spots, interview well, and have a well-rounded CV, that they ought to be able to match.

It is more of a call to all attendings who are mentors, or even PDs, to discuss openly and honestly what plans ought to be. That means they need to remain aware of the changing environment of #spots/#applicants to their specialty and trends including applicant statistics. Nobody wants to squash someone's dream, especially if they like the student as a person and think they will make a great physician. I get that. However, the discussion of options needs to be frank and the students need to understand the consequences of having to move down the backup-plan path.

Bad advice is the worst, especially when you are boxed in to a small institution, small department for your specialty, and really don't have great resources for advice short of cold-calling PDs who probably don't have the time or comfort level helping advise some unknown student on how to apply to (potentially) their program. This obviously won't be a concern for people in powerhouse med schools, as there is no shortage of great advisors, as long as they do reach out and ask for help.

You mention the need for a "backup plan" but every graduating physician should think about this. This is nothing new. Since the match has been conducted there have been "top students" who have ranked 3 programs, all highly competitive, in a tough specialty, and assumed they would be alright and then fail to match. No one should be leaving the question of "will I match or not" to chance. If you are at all worried, you should be interviewing at programs that are as close to cinches as possible, and putting them last on your list.

I do agree, but I still think that "top students" ranking only 3 programs are idiots. Everyone needs a backup plan, even if that is simply to apply to more programs than you would have needed to in previous years. Most people I knew in med school, including the very confident ones, knew they still needed to play the odds game. They practically memorized the Charting Outcomes and ran their own statistical analysis on it. 🙂

I never meant to incite panic in med students, just a good dose of reality. If they are receiving advice that is all warm and fuzzy but not realistic, we will repeat what happened this past match. If you want FM, then it's really not that difficult to get in unless you really limit your app. If you want a competitive specialty, there is a difficult road ahead. I'm sure it was not a coincidence that we kept seeing the same 20-30 people at interviews across the country, when the applicant pool was in the several hundreds. And therefore not a surprise that many did not match who would have in the past. This was a factor of more apps/spot. I don't know anyone who did not apply to all of the programs in uber-competitive but small specialties or 60+ of the larger pool (but still competitive) specialties.

 

[FDoRoML]

Actually, if you read the 2005 press releases of the AAMC, this crunch is by design -- to push the offshore grads out of the equation.

Yeah, I did realize this. And I guess that would make some programs potentially better since they would be getting US-trained grads instead of FMGs who are rough around the edges. There will still be stellar FMGs getting spots, though. It is great for FM, especially the enormous amount of programs who traditionally went unfilled. Not so great for specialties limited in number. Well, it's good for those specialties, but not the applicants! They will get the best of the best, but some of the darned good applicants will no longer have a shot at what they want to do (or at least the shorter path to that specialty). With the mounting debt of grads, many feel urgency to get to practice ASAP so they can pay off loans, regardless of specialty choice. When you take those like back surgery, hand surgery, cardiology, plastics, interventional radiology (etc), there is already a ridiculously long pathway. For those hell-bent on doing these, having to take a path that may even veer them away (like having to do FM), and then reapply as a career-changer seems painful. Yes, where there is a will, there is a way. Those not completely dedicated will stay in wherever they ended up and those determined will just trudge through and still hopefully make it.

But, if we don't increase the # of spots, with projected shortages given the rising population, especially of the elderly, who is going to take care of the patients? We want better access to care and that does mean having enough physicians so that there isn't a 3-month wait for routine care, for chronic conditions, or for elective (but life-altering) surgery. At my med center we already have people traveling 3+ hours here to see the closest neurosurgeon or medical specialist... I am sure there are those who just don't bother to make the time or effort to take care of themselves, thus raising the costs to them and the system as their conditions get worse.

I was really just venting. Perhaps a treadmill would have been a better choice.

 

[Ronin2258]

Actually, if you read the 2005 press releases of the AAMC, this crunch is by design -- to push the offshore grads out of the equation. There has long been the sentiment that US schools should fill all US residency slots and the AAMC has been uncomfortable with the notion that there are physicians who get educated (esp) in the caribbean at programs not under the control of the LCME, and not subject to the same standards, and then come here to practice simply because we have more slots than we have grads. So having grads equal slots fixes this problem, and has the added bonus of forcing US grads into some of the primary care slots that were previously grabbed up by FMG due to being less desirable to the US crowd. This makes everyone happy other than the folks vying for a slot because the less desirable residency slots now get to choose US trained US grads, more US grads end up in primary care and FM (if only by default), and the LCME has the ability to oversee the training of everyone who becomes a US doctor. So that is the goal. And so no, there will be no pressure for the feds to increase slots because the AAMC doesn't want more slots until all the current ones are being filled by US grads.

My question is, what is going limit the programs from taking offshore grads prior to having all US grads in categorical slots? There are some residencies out there, fairly competitive, that have over half their incoming interns from offshore/overseas programs. Is there going to be some protectionism law enacted? Are overseas grads going to have to wait until all US grads are filled (overseas match?) I see a lot of people this year having a hard time even scrambling to a spot.

 

[vhawk]

Yeah, I did realize this. And I guess that would make some programs potentially better since they would be getting US-trained grads instead of FMGs who are rough around the edges. There will still be stellar FMGs getting spots, though. It is great for FM, especially the enormous amount of programs who traditionally went unfilled. Not so great for specialties limited in number. Well, it's good for those specialties, but not the applicants! They will get the best of the best, but some of the darned good applicants will no longer have a shot at what they want to do (or at least the shorter path to that specialty). With the mounting debt of grads, many feel urgency to get to practice ASAP so they can pay off loans, regardless of specialty choice. When you take those like back surgery, hand surgery, cardiology, plastics, interventional radiology (etc), there is already a ridiculously long pathway. For those hell-bent on doing these, having to take a path that may even veer them away (like having to do FM), and then reapply as a career-changer seems painful. Yes, where there is a will, there is a way. Those not completely dedicated will stay in wherever they ended up and those determined will just trudge through and still hopefully make it.

But, if we don't increase the # of spots, with projected shortages given the rising population, especially of the elderly, who is going to take care of the patients? We want better access to care and that does mean having enough physicians so that there isn't a 3-month wait for routine care, for chronic conditions, or for elective (but life-altering) surgery. At my med center we already have people traveling 3+ hours here to see the closest neurosurgeon or medical specialist... I am sure there are those who just don't bother to make the time or effort to take care of themselves, thus raising the costs to them and the system as their conditions get worse.

I was really just venting. Perhaps a treadmill would have been a better choice.

I guess I'm not quite sure how this is really a plus or a minus for these programs. US schools increase their enrollment, so they put out more US grads, which fill up all these spots, which take away from the AMGs and FMGs. Ok. Where did all these extra US grads come from, were they just invented out of thin air? No, these are spots which are going to be filled by the best AMGs and FMGs (mostly AMGs I'd imagine). So...basically, from the programs' perspective, they are going to be getting essentially the exact same grads.

But now they have a fancier, more expensive diploma. But they are basically exactly the same people, in the same spots. Its obv that the LCME gains since basically nothing changes except they are now in control of a larger share of the market. And the Caribbean schools will pay.

 

[turquoiseblue]

Yeah, I did realize this. And I guess that would make some programs potentially better since they would be getting US-trained grads instead of FMGs who are rough around the edges. There will still be stellar FMGs getting spots, though. It is great for FM, especially the enormous amount of programs who traditionally went unfilled. Not so great for specialties limited in number. Well, it's good for those specialties, but not the applicants! They will get the best of the best, but some of the darned good applicants will no longer have a shot at what they want to do (or at least the shorter path to that specialty). With the mounting debt of grads, many feel urgency to get to practice ASAP so they can pay off loans, regardless of specialty choice. When you take those like back surgery, hand surgery, cardiology, plastics, interventional radiology (etc), there is already a ridiculously long pathway. For those hell-bent on doing these, having to take a path that may even veer them away (like having to do FM), and then reapply as a career-changer seems painful. Yes, where there is a will, there is a way. Those not completely dedicated will stay in wherever they ended up and those determined will just trudge through and still hopefully make it.

But, if we don't increase the # of spots, with projected shortages given the rising population, especially of the elderly, who is going to take care of the patients? We want better access to care and that does mean having enough physicians so that there isn't a 3-month wait for routine care, for chronic conditions, or for elective (but life-altering) surgery. At my med center we already have people traveling 3+ hours here to see the closest neurosurgeon or medical specialist... I am sure there are those who just don't bother to make the time or effort to take care of themselves, thus raising the costs to them and the system as their conditions get worse.

I was really just venting. Perhaps a treadmill would have been a better choice.

there was an upcoming bill to increase spots by 15,000 but it seems to not be taking effect. i wondered the same thing, as to why aren't they increasing the number of spots after foreseeing a population increase, but seems that NP's are going to take over the place where the doctors didn't, just so doctor salaries can stay high. However, if the population increases, the doctor salaries will probably be just as high. then again if they keep the number of residency slots and there are less doctors the salary will be even higher and the doctors will be working harder, which they seem to have no problem with.

somehow the population has to increase to the point that the average doctor can't handle that increase in patients, where something's gotta give, and i think only then will they want to increase the # of residency spots...either that or make NP's completely independent like doctors, which seems to be a possible trend. i guess we can only wonder what the future holds.

 

[vhawk]

As many have said before, simply adding residency spots is not the solution. Many of us in subspecialties or fellowships do not want to see additional spots. Why would I, in a specialty that graduates 120 or so a year, want more graduates in my specialty. With limited numbers we can demand higher compensation. We can treat more patients per physician and increase revenue. These are good things.

lol. Yes, they are good things....for you. Bad for essentially everyone else. But hopefully we can punish everyone else and keep things sweet for you by artificially reducing the supply and driving your compensation up. I share your confidence that this is the ultimate goal of everyone involved.

 

[Obnoxious Dad]

As many have said before, simply adding residency spots is not the solution. Many of us in subspecialties or fellowships do not want to see additional spots. Why would I, in a specialty that graduates 120 or so a year, want more graduates in my specialty. With limited numbers we can demand higher compensation. We can treat more patients per physician and increase revenue. These are good things.

In just one paragraph you have reinforced the opinions of many about physicians. Could you possibly be more selfish? You would deny residencies to medical school graduates and delay treatment to patients just to stuff your own pockets. You make me sick.

 

[FDoRoML]

...seems that NP's are going to take over the place where the doctors didn't... either that or make NP's completely independent like doctors, which seems to be a possible trend.

😱

 

[nedi292]

This is what happened
There are about 400 people mostly US citizens that were eligible but didn't get residency
http://www.thepetitionsite.com/1/j1-visa-abuse

 

[odieoh]

This is what happened
There are about 400 people mostly US citizens that were eligible but didn't get residency
http://www.thepetitionsite.com/1/j1-visa-abuse

Not true. 400 people or so signed the petition. Only a few of them actually state that they are citizens and unable to find a residency.

I understand to some extent the argument that citizens should get first crack at residencies. But I also like the merit -based aspect of the current system. Lets face it, good competent applicants are getting spots. If you are consistently not matching, most likely it is a problem with you or some aspect of your academic past. I also find the wording on that petition really annoying. . . "This is the only way to ensure that local doctors are given the jobs that they deserve." Yeah because you "deserve" a residency spot if you failed to get in to a US school and bought your way in through the Caribbean backdoor.

I also love the argument that residencies should pay no attention to USMLE scores because "passing is good enough and that's all that matters." Lets compare residents to apples at the market and program directors are buyers passing through the market. Naturally the PD's are going to pick the shiniest brightest apples. And naturally there are going to be a few apples with bruises on them. When the shiny apples are gone, these will get bought as well. And likewise there will be a few that are bruised and moldy and half rotten. Likely the latter will never be picked by the buyers. It would do no good for the rotten ones to scream "Hey, we are apples too!! WTF?? I don't understand why you don't pick us, we are all just apples, that's all that matters! Bottom line, shiny apples get picked, even if they are Indian or Iranian. Rotten apples sit on the table, even if they are American. That's all there is to it.

 

[turquoiseblue]

This is what happened
There are about 400 people mostly US citizens that were eligible but didn't get residency
http://www.thepetitionsite.com/1/j1-visa-abuse

There are much more than just 400 US citizens not chosen....it is listed in the nrmp tables...those on the petition site are only the number of people that are in favor of the petition....

 

[phospho]

In just one paragraph you have reinforced the opinions of many about physicians. Could you possibly be more selfish? You would deny residencies to medical school graduates and delay treatment to patients just to stuff your own pockets. You make me sick.

Dude, you've never even been to medical school, let alone experienced residency. I think his/her post is right on. After all the crap I've been through, I would hate for them to increase residency spots because that will bring our salaries down. What in the world do you know about throwing away a decade and a half of your life away? Someone who has 300+ posts because his KID is in medical school (LOL) has no right whatsoever to insult and call a physician "vile", "selfish" and "sick".

But then again, in just one paragraph, you have reinforced the opinions of many physicians/med students/residents about the general public: you are CLUELESS.

 

[bronx43]

Dude, you've never even been to medical school, let alone experienced residency. I think his/her post is right on. After all the crap I've been through, I would hate for them to increase residency spots because that will bring our salaries down. What in the world do you know about throwing away a decade and a half of your life away? Someone who has 300+ posts because his KID is in medical school (LOL) has no right whatsoever to insult and call a physician "vile", "selfish" and "sick".

But then again, in just one paragraph, you have reinforced the opinions of many physicians/med students/residents about the general public: you are CLUELESS.

Why doesn't someone outside of medicine have the right to call physicians vile, selfish, or sick? I'm not saying physicians are; I'm questioning your logic as to why he can't make that assertion. If he can bring up reasonable arguments as to why his position is right, then his status is irrelevant. Do you think Fortune 500 CEOs or high financiers at Goldman Sachs make too much money (often at the expense of the shareholder or general public), and/or are socially irresponsible? If so, what makes your judgment any more valid than his about practitioners?

 

[badasshairday]

Dude, you've never even been to medical school, let alone experienced residency. I think his/her post is right on. After all the crap I've been through, I would hate for them to increase residency spots because that will bring our salaries down. What in the world do you know about throwing away a decade and a half of your life away? Someone who has 300+ posts because his KID is in medical school (LOL) has no right whatsoever to insult and call a physician "vile", "selfish" and "sick".

But then again, in just one paragraph, you have reinforced the opinions of many physicians/med students/residents about the general public: you are CLUELESS.

You finished one year of medical school... what do you mean all you have been through? MS1 year isn't so terrible.

Throwing away a decade and a half of your life away? If that is the way you want to look at it, then I guess that is right. For many others, it is called living life doing what you want to do.

I too believe physicians should be compensated properly for their service. But seriously, try to be positive, it does wonders. 👍

 

[smq123]

In just one paragraph you have reinforced the opinions of many about physicians. Could you possibly be more selfish? You would deny residencies to medical school graduates and delay treatment to patients just to stuff your own pockets. You make me sick.

Before you continue ranting on your self-righteous soap box, consider the ramifications of increasing residency spots. As wagy27 already pointed out, more physicans would lead to decreasing reimbursement. Maybe not such a big deal for YOU, but for your CHILD (i.e. the one in medical school), it could mean that her debt wouldn't get paid off for 30, instead of 20, years. If the idea of your child getting paid less for her efforts doesn't bother you, then, well....

Furthermore, it's not just a money thing. Residency requires that you have enough patients to adequately learn from. More residents equals less hands-on experience, since you're dividing up the same number of patients among them.

You finished one year of medical school... what do you mean all you have been through? MS1 year isn't so terrible.

Speak for yourself. WORST. YEAR. OF. MY. LIFE. EVER. For me, intern year was better!

 

[michaelrack]

Furthermore, it's not just a money thing. Residency requires that you have enough patients to adequately learn from. More residents equals less hands-on experience, since you're dividing up the same number of patients among them.

This might be an issue for a few specialties- neurosurgery, in which there are only a limited number of cases in a given geographic area.

With enough $ available for residency training, I don't see any difficulty in finding enough patients for primary care or psychiatry residencies.

My local univ med center (the univ of MS) is currently building clinics in rich areas and competing with private docs, but there are plenty of uninsured and medicaid patients out there that no one is fighting for.

 

[smq123]

This might be an issue for a few specialties- neurosurgery, in which there are only a limited number of cases in a given geographic area.

With enough $ available for residency training, I don't see any difficulty in finding enough patients for primary care or psychiatry residencies.

My local univ med center (the univ of MS) is currently building clinics in rich areas and competing with private docs, but there are plenty of uninsured and medicaid patients out there that no one is fighting for.

As someone in a primary care residency, we actually do sometimes run into a problem where we don't have enough OB patients to fulfill our continuity clinics. We are in an area oversaturated with OB/gyns that it can sometimes become an issue.

And getting more residents to see the same number of pts. is still a sticking point, even in primary care residencies. The thought that seeing, say, 450 patients over 3 years leaves you just as experienced as seeing 800, is an argument that I'm not sure that even the general public is willing to buy.

 

[phospho]

Why doesn't someone outside of medicine have the right to call physicians vile, selfish, or sick? I'm not saying physicians are; I'm questioning your logic as to why he can't make that assertion. If he can bring up reasonable arguments as to why his position is right, then his status is irrelevant. Do you think Fortune 500 CEOs or high financiers at Goldman Sachs make too much money (often at the expense of the shareholder or general public), and/or are socially irresponsible? If so, what makes your judgment any more valid than his about practitioners?

honestly, I have never commented on how much money these CEO's make, why? because I can never know what it's like to be in their shoes. Yes, I believe that since he's not in medicine, he should at least realize that there might be something he's missing or not looking at before he goes on some rant about how vile and sick someone is!

 

[phospho]

You finished one year of medical school... what do you mean all you have been through? MS1 year isn't so terrible.

Throwing away a decade and a half of your life away? If that is the way you want to look at it, then I guess that is right. For many others, it is called living life doing what you want to do.

I too believe physicians should be compensated properly for their service. But seriously, try to be positive, it does wonders. 👍

I didn't mean to try to be negative. I've never posted anything on this residency forum because I'm still a medical student, but when I saw that post, I got pissed because you have this dude who has no idea what kind of sacrifices we have given. Don't get me wrong, I want to do those sacrifices. You know and I know that it's not only a year that I've given up to be where I am right now.

I actually gave up a career in finance. I quit my job when I started studying for the MCAT and was making close to 105K and I was only 24 years old. Again, I wanted to do those sacrifices. But don't tell me this guy who has NO clue what we go through has the right to come on this forum and call someone "SICK" and "VILE"...

either way, it seems like I'm the only one who thinks that way... sorry for being so negative (not trying to be a smartass)

 

[michaelrack]

As someone in a primary care residency, we actually do sometimes run into a problem where we don't have enough OB patients to fulfill our continuity clinics. We are in an area oversaturated with OB/gyns that it can sometimes become an issue.
.

That's interesting to here. Do you see uninsured and medicaid patients in your continuity clinics?

 

[smq123]

That's interesting to here. Do you see uninsured and medicaid patients in your continuity clinics?

Yep...that's where the bulk of our OB continuity patients come from - Medicaid or self-pay.

 

[Obnoxious Dad]

Without going into enough detail to identify myself, I will tell you that I have observed academic medicine (second hand) for the past 30 years. I hold a law degree and advanced degrees in public policy and business. While I wouldn't know a kidney if you slapped me with one, I know a damned sight more about the economy and the law than the economic and legal imbeciles who fill the ranks of the medical profession.

I was appalled by Wagy's post because the evidence that we are about to see a severe shortage of physicians is practically overwhelming. In some places people with jobs and insurance can't get access to medical care right now. Innocent people who are injured in accidents can't get to a general surgeon. This is horrifying.

The only physicians who should worry about unemployment and poor compensation are those who are either addicted or incompetent. I can understand the paranoia of some medical students about debt but in only the most extreme cases are young physicians really suffering with debt. Furthermore the physicians who will suffer the most from debt are those who can't get a residency.

Finally if any of you think you are really suffering in medical school I would suggest that you follow around a New York cop or a soldier in Afghanistan. You'll be counting your many blessings.

 

[bronx43]

honestly, I have never commented on how much money these CEO's make, why? because I can never know what it's like to be in their shoes. Yes, I believe that since he's not in medicine, he should at least realize that there might be something he's missing or not looking at before he goes on some rant about how vile and sick someone is!

So, basically your position is that one's income is determined only by whatever purely subjective "stresses" they endure in their said occupation. And that the only people who can comment on Goldman and AIG CEOs are the CEOs themselves, regardless of the fact that not only can their services be retained at far lowers costs (demonstrating superfluous cash outflow and inefficiency), but also that their enormous compensation packages are often crippling to their very institution by draining it of investing capital (needed for reinvestment in the company and other operational costs) - both critiques can very easily be made by outside observers.

His not being in medicine may very well cause him to have a distorted view of the profession, but you can't assume the errors in his argument until he actually presents one. He may either be correct, or wrong - both of which are independent events with regards to his status as a medical doctor. I don't necessarily agree with his position, but using the argument "you aren't a doctor, so you don't know" is laughably naive.

 

[bronx43]

I didn't mean to try to be negative. I've never posted anything on this residency forum because I'm still a medical student, but when I saw that post, I got pissed because you have this dude who has no idea what kind of sacrifices we have given. Don't get me wrong, I want to do those sacrifices. You know and I know that it's not only a year that I've given up to be where I am right now.

I actually gave up a career in finance. I quit my job when I started studying for the MCAT and was making close to 105K and I was only 24 years old. Again, I wanted to do those sacrifices. But don't tell me this guy who has NO clue what we go through has the right to come on this forum and call someone "SICK" and "VILE"...

either way, it seems like I'm the only one who thinks that way... sorry for being so negative (not trying to be a smartass)

So... sounds like you were an i-banker. What bank? Just curious.

 

[smq123]

I was appalled by Wagy's post because the evidence that we are about to see a severe shortage of physicians is practically overwhelming. In some places people with jobs and insurance can't get access to medical care right now. Innocent people who are injured in accidents can't get to a general surgeon. This is horrifying.

I think that the statement "people with insurance can't get access to medical care right now" is a little misleading. And the statement that "innocent people who are injured in accidents can't get to a general surgeon" is emotionally powerful, but doesn't tell the whole picture.

I see patients who have "insurance" - really, they have Medicaid. They can't get access to great medical care from specialists....not because we have anywhere near a shortage of specialists in the area, though. The specialists in our area will not accept their insurance, and that's really the crux of their problem. Does that mean that we have a "physician shortage"? No, definitely not. It means that it's not financially feasible for many of the specialists to see these patients.

And, honestly, these Medicaid patients wouldn't even be able to see a primary care doctor if there weren't a residency program (i.e. us) that is, basically, forced to see them. Many of the primary care doctors in the area don't see Medicaid patients either.

As for patients who live in rural areas and can't see general surgeons - well, it's not because there's necessarily a catastrophic shortage of general surgeons. It's just that, if you're a general surgeon, do you really want to live in BFE? Being the only general surgeon in BFE, that means that you're basically on call 24/7 - kind of a tough sell for most people. So, most people choose to live in areas that are closer to big cities, have better schools, and have other surgeons nearby to help ease the pain.

Furthermore, the idea of increasing the number of general surgery residency spots would be a VERY tough sell. Among other things, that would lead to fewer cases per resident....again, not optimal.